One of the most effective forms of therapy for increasing physical functioning and improving your quality of life is not a pill and it’s not an exercise. It’s changing how you do your routine daily tasks by pacing.

The Pain and Fatigue Cycle

Have you noticed that if you are overly active, you get more pain or fatigue? When pain and fatigue set in, the natural response is to rest. Sometimes it seems like it takes a lot of rest in order to feel okay again.

When you rest for a long time, very little gets accomplished and the desire to be active becomes stronger. Since rest can result in less productivity, people with pain and fatigue tend to feel like they’re always behind and can’t catch up.

Once rested, there’s the temptation to be overly active in order to catch-up. The pain & fatigue cycle sets in again.

Will the Cycle Get Worse?

Yes. Self-esteem often drives people to be overly active. People often sacrifice their bodies in order to get things done.

It’s frustrating to have pain and fatigue set in at activity levels that once produced no pain or fatigue. This often leads people to overdo in order to prove they can still do the activity.

Why Does The Cycle Get Worse?

Studies show that when a person is stuck in the cycle, it takes less and less work to overdo and cause pain and fatigue. It also takes more rest to feel recovered.

Over time, it takes longer to recover from less work. More rest means less productive activity and more concern about being chronically behind.

When feeling better, there is a higher risk of overdoing and setting the cycle in motion again.

Can I Break the Cycle?

Yes! With your next new self-management skill …pacing! Most people use some form of pacing. But the method of pacing in this course is probably quite different from any form you’ve used before.

It’s NOT pacing when:

• "I do a task only to the point where I feel pain, then I rest".
  
  • If you are active to the point of pain, you’ve been active too long.
    
• "I do all my tasks in the morning and reserve the afternoon for rest."
  
  • Wearing yourself out in the morning insures the need for prolonged rest in the afternoon and maintains the cycle.
    
• "I only wash one car then take a rest; whereas I used to wash both".
  
  • Pacing based on the completion of a task can still result in overdoing.

TIME is the key to good pacing!

Here’s an example of how to use time in order to pace: If you know that you can be active at a specific task such as grocery shopping for 15 minutes before pain or fatigue worsen, then you would break the task into short active periods – 15 minutes at a time.

Shop for 15 minutes – rest – then shop for another 15 minutes. Stop and rest after 15 minutes even if you’re not finished. (You might rest in the pharmacy area where there’s usually a chair.) Alternate a time of activity with a time of rest, until you finish your task.

Activity…Rest…Activity…Rest…Activity…Rest…

How Do You Design Your Own Personal Pacing Schedule?

Select any activity you wish to pace. Estimate how long you can do the task "safely" without creating a flare-up in your symptoms. For most tasks, you’ll be able to work safely for a short period of time before your symptoms become noticeable. Determine the amount of time you can be active before you start to feel worse (the Danger Zone).

The "safe" zone (before symptoms worsen) will be the Activity time period. Base your future pacing of this activity on this time period (not when you’re ready to collapse or when the task is done).

Estimate a rest time period, enough to recover from that short period of activity.

Alternate: Activity time…rest time…activity time…rest time.

Track your progress. If you’re within the "Safe Zone," your activity won’t trigger a flare-up.

You can safely increase the activity time for this task gradually. For example, if after 3 days your symptoms do not worsen, increase the activity time just a few minutes (and try to keep the rest time the same). Keep increasing over 3 day intervals, as long as symptoms don’t worsen.

My symptoms worsen in just 5 minutes. If I rest that often, I’ll never get anything done!

Research has shown that people who use time-based pacing (as opposed to other types of pacing) actually get more accomplished.

By stopping before pain and fatigue set in, your body only needs to recover from the past period of activity (e.g. 15 minutes). Since you were not overly active, you will not need to rest long.

With pacing, you won’t need to recover all afternoon. And you avoid flare-ups. By avoiding flare-ups, you actually get more done by day’s end and don’t have to deal with increasing pain or fatigue.

Gradually increasing your activity can be accomplished with shorter and shorter rest breaks. And without increasing flare-ups.

Is there a "suggested" pacing schedule?

Time-based pacing works for very short periods (as little as 30 seconds of activity) and for longer periods (to a maximum of 2 hours of work followed by 15 minutes of rest). The "suggested pace" for healthy workers is 2 hours of work followed by 15 minutes of rest. In some factories, this is a required pacing schedule because it’s related to fewer injuries and increased productivity.

How many activities do I need to pace?

Ideally, you’d pace any activity that increases your pain or fatigue.

Can I pace the whole day, instead of just individual activities?

With practice, some people find that they can identify an activity-rest rhythm (like 50 minutes active and 10 minutes rest each hour) that can be applied across many activities and used throughout the day.

What do I do during the rest period?

Many people use brief relaxation exercises like deep breathing, yoga stretches or visualization in order to rest their minds and bodies. Others find working crossword puzzles, reading, praying, listening to relaxing music or a book-on-tape helpful.

Time-Based Pacing is hard to do!

You bet it’s hard to pace! "All work and no play" is not recommended. In fact, play is absolutely essential.

When people are in pain or feel fatigued, doing something pleasant is usually the last thing on their minds. In fact, when people are in pain, they usually have a hard time thinking of anything that would be pleasant.

Pain is associated with negative emotions such as sadness, frustration, and irritability. When people are in pain and also have these emotions, the pain becomes worse. That is because these emotions are processed in the same area of the brain as is pain. Research has shown that pain decreases when people experience more positive emotions.

Most people can’t just will themselves to feel happy. Perhaps the easiest way to introduce positive emotions is to engage in pleasant activity.

Easier said than done …

• When you’re not feeling well, it’s difficult to think of anything that could be pleasant.
  
• It may not be physically possible to do the activities that used to be fun.
  
• Often when you’re chronically ill, all energy is saved for getting the essentials done; no energy is left over for pleasant tasks.

Why is it important to schedule pleasant activities?

• They may not occur otherwise.
  
• You’ll enjoy them more if you schedule them at your best time of day.
  
• Sometimes, when they occur unplanned (and not paced), they can trigger a flare-up

Let’s learn the skills of Pacing & Pleasant Activity Scheduling. Go to Pacing – Skills >